Prosthetics and Orthotics International最新文献

Background: Over 52% of people who use a lower-limb prosthesis fall once every year, but fall risk is still not effectively screened. Few studies have identified clinical outcome measures that could help screen fall risk. Gait asymmetries between the intact and prosthetic limbs could also potentially help identify fall risk, based on findings in people with stroke. However, no studies have examined the relationship between gait asymmetries and falls in people who use a lower-limb prosthesis. Therefore, we sought to determine if any gait asymmetry parameters could significantly distinguish 12-month retrospective fallers from nonfallers.

Methods: People were recruited from private practice and the Amputee Coalition National Conference. Participants completed a 12-month retrospective fall history and 7 clinical outcome measures, as well as level-ground walking at self-selected pace with wearable sensors that collected kinematic (sagittal plane: hip, knee, and ankle range of motion) and kinetic (peak braking and propulsion ground reaction force) data.

Results: Twenty-two individuals who use a unilateral prosthesis participated (age 57.6 ± 14.2 years; 15 transtibial, 7 transfemoral). No gait asymmetry parameters significantly distinguished 12-month retrospective fallers from nonfallers. However, the Four Square Step Test did significantly distinguish fallers from nonfallers (P = 0.040, Hedge g = -0.739, area under the curve = 0.725, CI = 50-95%, cutoff time = 13.14 s), irrespective of level of prosthesis use. No parameters significantly distinguished fallers from nonfallers by level of prosthesis use (transtibial, transfemoral).

Conclusions: The Four Square Step Test cutoff time may be useful to distinguish fallers from nonfallers in unilateral lower-limb prosthesis users.

Background: Ankle foot orthoses (AFOs) improve ankle-foot stability and alignment. They might reduce the burden of care because they facilitate independent function. However, AFO use can add additional stressors such as adherence to wearing schedules and aiding with donning that might increase caregiver burden.

Objectives: The study aimed to quantify the burden experienced by family caregivers of children wearing AFOs in South Africa and to determine if there is a difference in the burden experienced by caregivers of children who have AFOs and those waiting for AFOs.

Study design: A cross-sectional survey was done in 4 South African provinces.

Methods: One hundred and twenty-three caregivers were identified through consecutive sampling. They completed the Burden Scale for Family Caregivers between March and June 2023. Descriptive and comparative analysis (χ2 test and Pearson correlation coefficient) were done.

Results: Eighty-three (67.48%) children had an AFO, whereas 40 (32.52%) needed one. The mean caregiver burden score for caregivers of children with AFOs was 21.82/60 (standard deviation 6.49), and for caregivers of children needing AFOs was 24.60 (standard deviation 5.63). Most family caregivers (69; 83.13%) of children with AFOs and children needing AFOs (32; 80.00%) experienced no to mild levels of burden. The difference in burden experienced by the 2 groups was not statistically significant (P = 0.671082).

Conclusions: Caregivers of children who can walk and use AFOs experience low to moderate levels of burden. AFOs did not reduce the caregiver burden statistically. However, clinically the burden experienced by caregivers was reduced.

Background: Ankle proprioception deficit is a major factor causing balance dysfunction in subacute stroke survivors. However, there is still no commonly-agreed ankle proprioception evaluation method for these patients. Whether ankle proprioception tested by the active movement extent discrimination apparatus (AMEDA) when participants are standing (AMEDA-standing) or sitting (AMEDA-sitting).

Objectives: This study aimed to investigate the variations in ankle proprioception measures between the AMEDA-standing and AMEDA-sitting in subacute stroke survivors and assess the test-retest reliability of these measures.

Study design: This study analyzes sitting and standing proprioception (AMEDA scores) and their associations with static/dynamic balance in 24 subacute stroke patients using ANOVA, Pearson's correlation, and ICC analyses in SPSS 26.

Methods: The battery of tests administered included the AMEDA, the Timed Up and Go Test, the Single-leg Stance, and the Limit of Stability, as measured by the NeuroCom® Balance Manager® VSRTM. Pearson correlation was applied to discern the relationship between the acuity of ankle proprioception and balance. The intraclass correlation coefficient was used to gauge the test-retest reliability of the measures. Furthermore, an analysis of variance was conducted to scrutinize any differences between the proprioception scores obtained from the AMEDA-standing and AMEDA-sitting protocols.

Results: Area under the curve values for the AMEDA-sitting during the initial test and retest were 0.665 (0.090) and 0.665 (0.080), respectively. For the AMEDA-standing, the area under the curve values were 0.697 (0.069) for the initial test and 0.699 (0.075) for the retest. Evaluating the reliability, the intraclass correlation coefficient was calculated as 0.704 for AMEDA-sitting, while for AMEDA-standing, it was 0.752. Upon conducting a Pearson correlation analysis, a statistically significant relationship was observed between AMEDA-sitting and several balance variables: Reaction Time-affected, Endpoint Displacement-affected, Max Excursion-affected, Endpoint Displacement-unaffected, Max Excursion-unaffected, and Endpoint Displacement-back.

Conclusions: In the context of subacute stroke survivors, both AMEDA-standing and AMEDA-sitting methodologies prove to be appropriate, demonstrating commendable test-retest reliability.

Background: Several outcome measures can be performed to assess and quantify mobility after a lower limb amputation. The Prosthetic Limb Users Survey of Mobility (PLUS-M) is a self-report instrument developed to assess mobility in prosthesis users. It has already been translated into different languages but not into Brazilian Portuguese.

Objectives: To perform the translation and cultural adaptation into Brazilian Portuguese of the PLUS-M and to assess its validity and reliability.

Study design: Observational cross-sectional study.

Methods: Translation and cultural adaptation were performed by following internationally recognized standards. To assess construct validity, the T-scores of PLUS-M/12-Item Short Form-Brazilian Portuguese (BR-12) item short form were correlated to the 2-Minute Walk Test and the scores from the Medical Outcomes Study 36-Short Form Health Survey domains by the Spearman correlation coefficient (ρ). A second administration of the PLUS-M/BR-12 was done by phone call to assess test-retest reliability.

Results: Some cultural adaptations were made to improve understanding. The PLUS-M/BR-12 T-scores of 61 participants showed a strong correlation between the scores of the 2-Minute Walk Test (ρ = 0.69) and the Physical Function domain of the 36-Short Form Health Survey (ρ = 0.83), and an excellent test-retest reliability (intraclass correlation coefficient = 0.90 [IC 95% = 0.833-0.943]; F (49,49) = 19,037; P < 0.001).

Conclusions: The PLUS-M/BR-12 demonstrated evidence of validity and reliability in assessing mobility in Brazilian adults with lower limb amputations who use a prosthetic device, and it is suitable for use in clinical care.

Objectives: The aim of this study was to systematically review the literature to identify factors that may influence quality of life in people with lower-limb amputation (all etiologies). Our primary focus was on identifying factors that can be modified, enabling a more concentrated integration of these aspects into the care and treatment of amputated patients.

Data source: Medline (via Ovid) and Scopus were searched in January 2023 for studies assessing quality of life for people with lower-limb loss. Studies were included if they reported on factors that could influence quality of life. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.

Study selection: Studies were identified and assessed independently by 2 reviewers.

Data extraction: Data were extracted by 2 independent reviewers.

Data synthesis: After removing duplicates, the search yielded 2616 studies, of which 24 met our inclusion criteria (cross-sectional n = 13; prospective n = 9; retrospective n = 2). The most commonly used quality-of-life instruments were the Short Form 36, followed by the World Health Organization Quality of Life-BREF and the EuroQoL 5 dimension. Younger age, traumatic etiology, unilateral or below-knee amputation, presence of comorbidities, and social integration were found to influence quality of life in people with lower-limb amputation, whereas sex and socioeconomic context do not seem to have a clear influence.

Conclusions: This systematic review of the literature identified several factors that influence quality of life in patients with lower-limb amputation. However, the results are not always consistent across studies and there is still no consensus on some factors. Conclusive findings regarding sex and socioeconomic status remain elusive, primarily because of substantial disparities observed across the literature. Future prospective longitudinal studies with clear a priori inclusion of a wide range of potential factors are needed to clarify the impact of the identified factors. Factors such as age, type of amputation, comorbidities and social integration should be considered in the management of patients with amputation.

Background: People with lower limb loss (LLL) have reduced physical activity (PA). There is evidence of physical and psychosocial predictors of PA in older adults with limb loss. However, these 2 areas (physical/psychosocial) have not been evaluated in the same analysis.

Objectives: To describe and identify predictors of PA in individuals with LLL.

Study design: Cross-sectional study.

Methods: Secondary analysis of data from a multisite Canadian randomized control trial involving community-dwelling prosthetic ambulators with unilateral transtibial or transfemoral amputation (N = 72). The dependent variable was the Physical Activity Scale for the Elderly. Potential predictors were four step square test, 2-minute walk test, Short Physical Performance Battery, Life Space Assessment, walking while talking test, and Activities-specific Balance Confidence scale.

Results: Seventy-two community-dwelling lower limb prosthesis users were enrolled. The sample included 62 male participants (86%), and 58 participants (81%) had transtibial amputation. The average age of participants was 65 (8.9) years, and for 49 participants (70%), the amputation was over 24 months ago. The total mean Standard Deviation (SD) Physical Activity Scale for the Elderly score was 153.2 (88.3), with scores of 148.1 (11.4) and 184.5 (24.7) for male and female participants, respectively. Regression analysis identified Life Space Assessment (β = 1.15, p = 0.007) and Short Physical Performance Battery (β = 3.51, p = 0.043) as statistically significant predictors accounting for 25% of the variance in PA.

Conclusions: Community mobility and physical performance are the most meaningful predictors of PA. Future research should examine additional factors (e.g., environment, motivation). Understanding the predictors for PA after LLL would improve clinical practice as clinicians would have increased knowledge to modify and improve training.

Background: The subtalar joint axis (STJA) occupies a key role in the dynamics of the lower limb kinetic chain, and its location has a wide interindividual variability. It has been suggested that considering the STJA location when designing foot orthoses may help to apply the required mechanical dose. However, the evidence is more anecdotal than empirical.

Objective: This study aimed to evaluate the reliability of the STJA digitization, a procedure combining the clinical determination of the functional STJA location and its subsequent 3-dimensional (3D) scanning.

Study design: Two examiners identified the posterior and anterior exit points of the functional STJA on the skin of 15 healthy participants using a clinical method in a repeated-measure design.

Methods: A handheld 3D scanner was used to scan the feet and the skin markers. The 3D coordinates of the skin markers were subsequently quantified and (1) STJA digitization intratester within-session, (2) STJA digitization intratester between-session, and (3) STJA digitization intertester between-session reliabilities were evaluated.

Results: When pooling all skin marker 3D coordinates, intraclass correlation coefficients (ICCs) for the STJA intratester within-session reliability ranged from 0.74 to 0.98. ICCs for the STJA digitization intratester between-session reliability ranged from 0.58 to 0.94. ICCs for the STJA digitization intertester reliability ranged from 0.56 to 0.81. Standard error of measurement for the mediolateral position of the talus marker (anterior exit point of the STJA) was substantially higher than that for the other coordinates.

Conclusions: Overall, the STJA digitization demonstrated a good intratester between-session reliability and may be used in a computer-aided design and computer-aided manufacturing workflow to create foot orthoses. However, further efforts should be considered to improve the scanning process and intertester reliability.